Healthcare Provider Details

I. General information

NPI: 1407240765
Provider Name (Legal Business Name): VICTORIA NICOLE VINSANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 COUNTRY CLUB RD UNIT A
COLUMBUS OH
43213
US

IV. Provider business mailing address

839 OAK ST
COLUMBUS OH
43205-1142
US

V. Phone/Fax

Practice location:
  • Phone: 614-501-7337
  • Fax: 614-434-2701
Mailing address:
  • Phone: 513-646-9756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1407240765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: